Many people come to see us with a diagnosis of "impingement" but don't know what that means. The purpose of this blog is to help you understand what is happening in your shoulder that could lead to your doctor telling you that you have shoulder impingement.
Anatomy
The shoulder is complex anatomically, but shoulder impingement is something that happens when one of two muscles pinches against a bone. Impingement usually happens from an overuse of the shoulder. So let's look a bit more closely about the anatomy.
Here is a video that will help you learn the anatomy:
So impingement is basically an inflammation of an irritated muscle, either the long head of the biceps or the supraspinatus of the rotator cuff. Most of the time it is caused by overuse of the shoulder in overhead positions; think swimming, throwing, serving in tennis, etc.
How To Diagnose Impingement of the Shoulder
When we treat someone with shoulder issues and they want to get back to using their arm as much as possible, we will take them through a battery of tests to see what is causing the pain and what structures are involved.
Impingement as become a catch-all term for a lot of other shoulder issues, so we want to make sure we are actually dealing with impingement as opposed to bursitis or adhesive capsulitis (frozen shoulder). That is why sometimes it is best to just come in with shoulder pain and find out what it is after your thorough evaluation.
If you have a few things that come back as positive, then we can confidently say that you have some impingement issues. Those things include:
Symptoms brought on by reaching or lifting overhead
Positive Impingement tests (We like to do 2 or 3 when you are with us)
Tenderness in either the bicep long head tendon or the supraspinatus muscle/tendon.
Recent increase in overhead type activity
Usually you will have at least 2 or 3 of these findings if you have a true impingement. If you don't have that many, it is likely something else and we can help you figure that out.
How Do You Fix It?
The best way to fix impingement is to calm down the symptoms first. Then we can look at your movement and see if we need to make any changes to the way you are moving. It might be that your ribcage isn't letting your shoulder move all the way and that is why you are getting impingement. Then we will start to strengthen the muscles of the shoulder and the good movement patterns. During this time, we will have you continue to participate, as much as possible without pain, in your normal activities.
When addressed quickly, we can help you avoid surgery or injections to the area. If left alone, it can progress into a rotator cuff lesion or tear.
Can it Heal Without Rehab?
The simple answer is yes it can heal. It is inflammation of a muscle, and if you just rest, you can be relatively pain free in a couple of days to a couple of weeks. The problem with this is that you are not addressing the underlying issue or figuring out the cause of your shoulder problems so it is likely to return. At BodyFix PT and Performance we want our clients to feel confident that they can return to full activity with minimal risk of aggravating the shoulder.
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